Abortion in the United States

Abortion in the United States has been and remains one of the most controversial issues in United States culture and politics. Various anti-abortion laws have been on the statute books of each state since at least 1900. In 1973, abortion was prohibited entirely in 30 states and legal in limited circumstances (such as pregnancies resulting from rape or incest) in 20 other states. In that year, the Supreme Court in Roe v. Wade invalidated all of these laws, and set guidelines for the availability of abortion. Roe established that the right of privacy of a woman to obtain an abortion "must be considered against important state interests in regulation."^[1] Roe established a "trimester" (i.e., 12 week) threshold of state interest in the life of the fetus corresponding to its increasing "viability" (likelihood of survival outside the uterus) over the course of a pregnancy, such that states were prohibited from banning abortion early in pregnancy but allowed to impose increasing restrictions or outright bans later in pregnancy.

That decision was modified by the 1992 case Planned Parenthood v. Casey, which upheld the "central holding" in Roe, but replacing the trimester system with the point of fetal viability (whenever it may occur) as defining a state's right to override the woman's autonomy. Casey also lowered the legal standard to which states would be held in justifying restrictions imposed on a woman's rights. Roe had held this to be "strict scrutiny"—the traditional Supreme Court test for impositions upon fundamental Constitutional rights—whereas Casey created a new standard referring to "undue burden", specifically to balance the state's and the woman's interests in the case of abortion.

Before Roe v. Wade, abortion was legal in several states of the United States, but that decision imposed a uniform framework for state legislation on the subject, and established a minimal period during which abortion must be legal (under greater or lesser degrees of restriction throughout the pregnancy). That basic framework, modified in Casey, remains nominally in place, although the effective availability of abortion varies significantly from state to state as many counties have no abortion providers.^[2]

In the United States, the main actors in the abortion debate are most often labelled either as "pro-choice" or "pro-life", though shades of opinion exist, and most Americans are considered to be somewhere in the middle.^[3] In a Gallup.com survey of 1014 adults found that opinions on abortion in the United States remain nearly evenly split, with 46% of participants identifying as pro-life and 47% identifying as pro-choice.^[4] The poll results also indicated that Americans harbor a diverse and shifting set of opinions on the legal status of abortion in the US; the survey polled that only 28% of respondents believed abortion should be legal under any circumstances, and 48% of respondents believed that abortion should be legal under "most" or "only a few circumstances." Recent polling results also found that only 34% of Americans were satisfied with abortion laws in the United States.^[4]

Terminology

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, and this is also how the term is used in a legal sense.^[5] Another term sometimes used is that of an "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. In medical parlance, abortion can refer to miscarriage or abortion, but not after the fetus is viable. Doctors call abortions termination of pregnancy after viability.

History

Eighteenth century commentary

Abortion laws in the U.S. before Roe.

  Illegal. (30)

  Legal in case of rape (1)

  Legal in case of danger to woman's health (2)

  Legal in case of danger to woman's health, rape or incest, or likely damaged fetus (13)

  Legal on request (4)

At the time of the independence of the United States, English common law on abortion applied in most of the then states, and abortion was not permitted after quickening, that is after the start of fetal movements, usually felt around 15-20 weeks after conception.^[6] James Wilson, a framer of the U.S. Constitution, explained the view as follows:

Abortions became illegal by statute in Britain in 1803 and various anti-abortion statutes began to appear in the United States from the 1820s codifying or expanding the common law rules. In 1821, a Connecticut law targeted apothecaries who sold "poisons" to women for purposes of inducing an abortion, and New York made post-quickening abortions a felony and pre-quickening abortions a misdemeanor eight years later. It is sometimes argued that the early American abortion laws were motivated not by ethical concerns about abortion but by concern about the safety of the procedure. However, some legal theorists point out that this theory is inconsistent with the fact that abortion was punishable regardless of whether any harm befell the pregnant woman and the fact that many of the early laws punished not only the doctor or abortionist, but also the woman who hired them.^[8]

A birth control movement developed during the 19th and early 20th centuries presaging the modern debate over women's body rights.^[9] A campaign was launched against the movement and the use and availability of contraceptives.

At the same time, the criminalization of abortion accelerated from the late 1860s, through the efforts of concerned legislators, doctors, and the American Medical Association.^[10] In 1873, Anthony Comstock created the New York Society for the Suppression of Vice, an institution dedicated to supervising the morality of the public, and later that year, Comstock successfully influenced the United States Congress to pass the Comstock Law, which made illegal the delivery through the U.S. mail of "obscene, lewd, or lascivious" material, as well as prohibiting any methods of production or publication of information pertaining to the procurement of abortion, the prevention of conception and the prevention of venereal disease, even to students of medicine.^[11] The production, publication, importation, and distribution of such materials was suppressed under the Comstock Laws as being obscene and similar prohibitions were passed by 24 of the then 37 states.^[12]

By 1900 abortion was a felony in every state. Some states did include provisions allowing for abortion in limited circumstances, generally to protect the woman's life or to terminate pregnancies arising from rape or incest. Abortions continued to occur, however, and increasingly became readily available. The American Birth Control League was founded by Margaret Sanger in 1921 to promote the founding of birth control clinics, to enable women to control their own fertility, as well as to promote Eugenics.^[13]

In the 1930s, licensed physicians performed an estimated 800,000 abortions a year.^[14]

Pre-Roe precedents

In 1964 Gerri Santoro of Connecticut died trying to obtain an illegal abortion and her photo became the symbol of the pro-choice movement. Some women's rights activist groups developed their own skills to provide abortions to women who could not obtain them elsewhere. As an example, in Chicago, a group known as "Jane" operated a floating abortion clinic throughout much of the 1960s. Women seeking the procedure would call a designated number and be given instructions on how to find "Jane".^[15]

In 1965, the U.S. Supreme Court case Griswold v. Connecticut struck down one of the remaining contraception Comstock laws in Connecticut and Massachusetts. However, Griswold only applied to marital relationships. Eisenstadt v. Baird (1972) extended its holding to unmarried persons as well. Following Griswold case, the American College of Obstetricians and Gynecologists (ACOG) issued a medical bulletin accepting a recommendation from 6 years earlier which clarified that conception is implantation, not fertilization; and consequently birth control methods that prevented implantation became classified as contraceptives, not abortifacients.

In 1967, Colorado became the first state to decriminalize abortion in cases of rape, incest, or in which pregnancy would lead to permanent physical disability of the woman. Similar laws were passed in California, Oregon, and North Carolina. In 1970, Hawaii became the first state to legalize abortions on the request of the woman,^[16] and New York repealed its 1830 law and allowed abortions up to the 24th week of pregnancy. Similar laws were soon passed in Alaska and Washington. A law in Washington, D.C., which allowed abortion to protect the life or health of the woman, was challenged in the Supreme Court in 1971 in United States v. Vuitch. The court upheld the law, deeming that "health" meant "psychological and physical well-being," essentially allowing abortion in Washington, DC. By the end of 1972, 13 states had a law similar to that of Colorado, while Mississippi allowed abortion in cases of rape or incest only and Alabama and Massachusetts allowed abortions only in cases where the womans's physical health was endangered. In order to obtain abortions during this period, women would often travel from a state where abortion was illegal to states where it was legal. The legal position prior to Roe v. Wade was that abortion was illegal in 30 states and legal under certain circumstances in 20 states.^[17]

In the late 1960s, a number of organizations were formed to mobilize opinion both against and for the legalization of abortion. In 1966, the National Conference of Catholic Bishops assigned Monsignor James T. McHugh to document efforts to reform abortion laws, and anti-abortion groups began forming in various states in 1967. In 1968, McHugh led an advisory group which became the National Right to Life Committee.^[18][19] The forerunner of the NARAL Pro-Choice America was formed in 1969 to oppose restrictions on abortion and expand access to abortion.^[20] Following Roe v. Wade, in late 1973 NARAL became the National Abortion Rights Action League.

Roe v. Wade

The United States Supreme Court membership in 1973.

In deciding Roe v. Wade on January 22, 1973, the Supreme Court ruled that a Texas statute forbidding abortion except when necessary to save the life of the mother was unconstitutional. The Court arrived at its decision by concluding that the issue of abortion and abortion rights falls under the right to privacy (in the sense of the right of a person not to be encroached by the state). In its opinion it listed several landmark cases where the court had previously found a right to privacy implied by the Constitution. The Court did not recognize a right to abortion in all cases:

State regulation protective of fetal life after viability thus has both logical and biological justifications. If the State is interested in protecting fetal life after viability, it may go so far as to proscribe abortion during that period, except when it is necessary to preserve the life or health of the mother.^[21]

The Court held that a right to privacy existed and included the right to have an abortion. The court found that a mother had a right to abortion until viability, a point to be determined by the abortion doctor. After viability a woman can obtain an abortion for health reasons, which the Court defined broadly to include psychological well-being.

A central issue in the Roe case (and in the wider abortion debate in general) is whether human life or personhood begins at conception, birth, or at some point in between. The Court declined to make an attempt at resolving this issue, noting: "We need not resolve the difficult question of when life begins. When those trained in the respective disciplines of medicine, philosophy, and theology are unable to arrive at any consensus, the judiciary, at this point in the development of man's knowledge, is not in a position to speculate as to the answer." Instead, it chose to point out that historically, under English and American common law and statutes, "the unborn have never been recognized ...as persons in the whole sense" and thus the fetuses are not legally entitled to the protection afforded by the right to life specifically enumerated in the Fourteenth Amendment. So rather than asserting that human life begins at any specific point, the court simply declared that the State has a "compelling interest" in protecting "potential life" at the point of viability.

Doe v Bolton

Under Roe v Wade, state governments may not prohibit late terminations of pregnancy when "necessary to preserve the [woman's] life or health", even if it would cause the demise of a viable fetus.^[22] This rule was clarified by the 1973 judicial decision Doe v Bolton, which specifies "that the medical judgment may be exercised in the light of all factors-- physical, emotional, psychological, familial, and the woman's age-- relevant to the well-being of the patient."^[23][24][25] It is by this provision for the mother's mental health that women in the US legally choose abortion after viability when screenings reveal abnormalities that do not cause a baby to die shortly after birth.^{[26][27][28][29]}

Jane Roe and Mary Doe

"Jane Roe" of the landmark Roe v. Wade lawsuit, whose real name is Norma McCorvey, is now a pro-life advocate. McCorvey writes that she never had the abortion and became the "pawn" of two young and ambitious lawyers who were looking for a plaintiff who they could use to challenge the Texas state law prohibiting abortion. However, attorney Linda Coffee says she does not remember McCorvey having any hesitancy about wanting an abortion.^[30]

"Mary Doe" of the companion Doe v. Bolton lawsuit, the mother of three whose real name is Sandra Cano, maintains that she never wanted or had an abortion and that she is "ninety-nine percent certain that [she] did not sign" the affidavit to initiate the suit.^[31]

Later judicial decisions

In the 1992 case of Planned Parenthood v. Casey, the Court abandoned Roe's strict trimester framework.^[32] Instead adopting the standard of undue burden for evaluating state abortion restrictions,^[33] but reemphasized the right to abortion as grounded in the general sense of liberty and privacy protected under the constitution: "Constitutional protection of the woman's decision to terminate her pregnancy derives from the Due Process Clause of the Fourteenth Amendment. It declares that no State shall 'deprive any person of life, liberty, or property, without due process of law.' The controlling word in the cases before us is 'liberty'."^[34]

The Supreme Court continues to grapple with cases on the subject. On April 18, 2007 it issued a ruling in the case of Gonzales v. Carhart, involving a federal law entitled the Partial-Birth Abortion Ban Act of 2003 which President George W. Bush had signed into law. The law banned intact dilation and extraction, which opponents of abortion rights referred to as "partial-birth abortion," and stipulated that anyone breaking the law would get a prison sentence up to 2.5 years. The United States Supreme Court upheld the 2003 ban by a narrow majority of 5-4, marking the first time the Court has allowed a ban on any type of abortion since 1973. The opinion, which came from justice Anthony Kennedy, was joined by Justices Antonin Scalia, Clarence Thomas, and the two recent appointees, Samuel Alito and Chief Justice John Roberts.

Current legal situation

Federal legislation

Since 1995, led by Congressional Republicans, the U.S. House of Representatives and U.S. Senate had moved several times to pass measures banning the procedure of intact dilation and extraction, also commonly known as partial birth abortion. After several long and emotional debates on the issue, such measures passed twice by wide margins, but President Bill Clinton vetoed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Congressional supporters of the bill argue that a health exception would render the bill unenforceable, since the Doe v. Bolton decision defined "health" in vague terms, justifying any motive for obtaining an abortion. Subsequent Congressional attempts at overriding the veto were unsuccessful.

The Born-Alive Infants Protection Act of 2002 ("BAIPA") was enacted August 5, 2002 by Act of Congress and signed into law by George W. Bush. It acknowledges the human rights of infants born after a failed attempt to induce abortion. A "born-alive infant" is specified to be a "person, human being, child, individual." "Born alive" is defined as the complete expulsion of an infant at any stage of development that has a heartbeat, pulsation of the umbilical cord, breath, or voluntary muscle movement, no matter if the umbilical cord has been cut or if the expulsion of the infant was natural, induced labor, cesarean section, or induced abortion.

On October 2, 2003, with a vote of 281-142, the House again approved a measure banning the procedure, called the Partial-Birth Abortion Ban Act. Through this legislation, a doctor could face up to two years in prison and face civil lawsuits for performing such an abortion. A woman who undergoes the procedure cannot be prosecuted under the measure. The measure contains an exemption to allow the procedure if the woman's life is threatened. On October 21, 2003, the United States Senate passed the same bill by a vote of 64-34, with a number of Democrats joining in support. The bill was signed by President George W. Bush on November 5, 2003, but a federal judge blocked its enforcement in several states just a few hours after it became public law. The Supreme Court upheld the nationwide ban on the procedure in the case Gonzales v. Carhart on April 18, 2007, signaling a substantial change in the Court's approach to abortion law.^[35] The 5-4 ruling said the Partial Birth Abortion Ban Act does not conflict with previous Court decisions regarding abortion.

The current judicial interpretation of the U.S. Constitution regarding abortion in the United States, following the Supreme Court of the United States's 1973 landmark decision in Roe v. Wade, and subsequent companion decisions, is that abortion is legal but may be restricted by the states to varying degrees. States have passed laws to restrict late term abortions, require parental notification for minors, and mandate the disclosure of abortion risk information to patients prior to the procedure.^[36]

The key, deliberated article of the U.S. Constitution is the Fourteenth Amendment, which states that

The official report of the U.S. Senate Judiciary Committee, issued in 1983 after extensive hearings on the Human Life Amendment (proposed by Senators Orrin Hatch and Thomas Eagleton), stated what substantially remains true today:

One aspect of the legal abortion regime now in place has been determining when the fetus is "viable" outside the womb as a measure of when the "life" of the fetus is its own (and therefore subject to being protected by the state). In the majority opinion delivered by the court in Roe v. Wade, viability was defined as "potentially able to live outside the mother's womb, albeit with artificial aid. Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks." When the court ruled in 1973, the then-current medical technology suggested that viability could occur as early as 24 weeks. Advances over the past three decades have allowed fetuses that are a few weeks less than 24 weeks old to survive outside the mother's womb. These scientific achievements, while life-saving for premature babies, have made the determination of being "viable" somewhat more complicated.

As of 2006, the youngest child to survive a premature birth in the United States was a girl born at Kapiolani Medical Center in Honolulu, Hawaii at 21 weeks and 3 days gestation gestational age.^[39] Because of the split between federal and state law, legal access to abortion continues to vary somewhat by state. Geographic availability, however, varies dramatically, with 87 percent of U.S. counties having no abortion provider.^[40] Moreover, due to the Hyde Amendment, many state health programs do not cover abortions; currently 17 states (including California, Illinois and New York) offer or require such coverage.^[41]

The legality of abortion in the United States is frequently a major issue in nomination battles for the U.S. Supreme Court. However, nominees typically remain silent on the issue during their hearings, because it is an issue that may come before them as judges.

The Unborn Victims of Violence Act, commonly known as "Laci and Conner's Law" was passed by Congress and signed into law by President Bush on April 1, 2004, allowing two charges to be filed against someone who kills a pregnant mother (one for the mother and one for the fetus). It specifically bans charges against the mother and/or doctor relating to abortion procedures. Nevertheless, it has generated much controversy among pro-choice advocates who view it as a potential step in the direction of banning abortion.

State-by-state legal status

The Guttmacher Institute found that state restrictions on abortion greatly increased in 2011.

This map demonstrate an increase in abortion restrictions and a simultaneous decrease in abortion access in the US in 2013. An index of abortion access was created using the supply of abortion providers, TRAP laws, gestational restrictions, and parental notification laws to measure abortion access in the US.

Various states have laws on abortion, some of which refer to as feticide. On March 6, 2006, South Dakota Governor Mike Rounds signed into law a pro-life statute which made performing abortions a felony, and that law was subsequently repealed in a November 7, 2006 referendum.^[42] On February 27, 2006, Mississippi's House Public Health Committee voted to approve a ban on abortion, and that bill died after the House and Senate failed to agree on compromise legislation.^[43] Several states have enacted "trigger laws" which "would take effect if Roe v. Wade is overturned."^[44] North Dakota HB 1572 or the Personhood of Children Act, which passed the North Dakota House of Representatives on February 18, 2009, but was later defeated in the North Dakota Senate, aimed to allocate rights to "the pre-born, partially born", and if passed, would likely have been used to challenge Roe v. Wade.^[45] On February 15, 2012, the Virginia House of Delegates passed House Bill 1 in a vote of 66-32, that effectively outlaws all Virginia abortions by declaring that the rights of persons apply from the moment sperm and egg unite. It also passed a second bill in a 63-36 vote, that requires women to have a transvaginal ultrasound before undergoing abortions.^[46]

In addition, some states have sought to ban abortion by means of an amendment to the state constitution, three of which have already reached the ballot for a vote. Colorado citizens voted on Amendment 48 on November 4, 2008, and it failed to pass, with 73.21% voting against it and 26.79% voting for it.^[47] A similar initiative, Amendment 62, made the Colorado ballot on November 2, 2010, where it failed again, this time 70.53% to 29.47%.^[48] On November 8, 2011, Initiative 26, a "personhood" measure that would have banned all abortions and some forms of contraception, was defeated on the Mississippi ballot, 57.87% voting "no" to 42.13%.^[49][50] All three of these amendments made it to the ballot through a citizen initiative process, as opposed to being referred to the ballot by their state legislatures.

These amendments, dubbed "personhood amendments," have so far contained far-reaching language that go beyond simply banning abortion. They define personhood as beginning from the moment of conception and/or fertilization, which would potentially outlaw forms of birth control, in addition to potentially banning in-vitro fertilization. The umbrella organization Personhood USA, based in Colorado and co-founded by Cal Zastrow and Keith Mason,^[51] was responsible for getting Amendments 48 and 62 onto the ballot in Colorado.^[52] Personhood USA also plans on pushing for such amendments in Montana and Oregon.^[53]

Other states are considering personhood amendments banning abortion, some through legislative methods and others through citizen initiative campaigns. Among these states are Florida, Ohio, Georgia, Texas, and Arkansas.^[54][55][56]

In 2015 Kansas became the first state to ban the dilation and evacuation procedure, a common second-trimester abortion procedure.^[57]

24 states have mandatory counseling and delay periods, while 6 states require in person counseling. ^[58]

Abortion in the Northern Mariana Islands, a United States Commonwealth, is illegal.

Qualifying requirements for abortion providers

Qualifying requirements for performing abortions vary from state to state.^[59] Currently, California, Oregon, Montana, Vermont, and New Hampshire allow qualified non-physician health professionals, such as physicians' assistants, nurse practitioners, and certified nurse midwives, to do first-trimester aspiration abortions, and to prescribe drugs for medical abortions. Additionally, Washington State, New Mexico, Illinois, Maryland, New York, Massachusetts, Connecticut, and New Jersey allow qualified non-physicians to prescribe drugs for medical abortions only. In all other states, only licensed physicians may perform abortions.^[60]

Statistics

Because reporting of abortions is not mandatory, statistics are of varying reliability. The Centers For Disease Control (CDC)^[61] regularly compiles these statistics.

Number of abortions in United States

The annual number of legal induced abortions in the United States doubled between 1973 and 1979, and peaked in 1990. There was a slow but steady decline through the 1990s. Overall, the number of annual abortions decreased by 6% between 2000 and 2009, with temporary spikes in 2002 and 2006.^[62]

According to the Guttmacher Institute, since 1973, roughly 50 million legal induced abortions have been performed in the United States.^[63]

By 2011, abortion rate in the United States dropped to its lowest point since the Supreme Court legalized the procedure. According to a study performed by Guttmacher Institute, long-acting contraceptive methods were having a significant impact in reducing unwanted pregnancies. There were fewer than 17 abortions for every 1,000 women of child-bearing age. That was a 13 percent decrease from 2008's numbers and slightly higher than the rate in 1973, when the Supreme Court's Roe v. Wade decision legalized abortion. The study indicated a long-term decline in the abortion rate. The rate has dropped significantly from its all-time high in 1981, when there were roughly 30 abortions for every 1,000 women of reproductive age. The overall number of abortions also fell 13 percent from 2008 to nearly 1.1 million in 2011." In 2013, the Centers for Disease Control and Prevention also reported a decline in abortion rates.^{[64][65][66][67]}

Even though abortion is legal, abortion can carry heavy social stigma; for this reason incidence of abortions may be difficult to measure because in medicine they can be reported variously as miscarriage, "induced miscarriage", "menstrual regulation", "mini-abortion", and "regulation of a delayed/suspended menstruation".^[68][69]

Medical abortions

A Guttmacher Institute survey of abortion providers estimated that early medical abortions accounted for 17% of all nonhospital abortions and slightly over one-quarter of abortions before 9 weeks gestation in the United States in 2008.^[70] Medical abortions voluntarily reported to the CDC by 34 reporting areas (excluding Alabama, California, Connecticut, Delaware, Florida, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, Pennsylvania, Tennessee, Vermont, Wisconsin, and Wyoming) and published in its annual abortion surveillance reports have increased every year since the September 28, 2000 FDA approval of mifepristone (RU-486): 1.0% in 2000, 2.9% in 2001, 5.2% in 2002, 7.9% in 2003, 9.3% in 2004, 9.9% in 2005, 10.6% in 2006, 13.1% in 2007, 15.8% in 2008, 17.1% in 2009 (25.2% of those at less than 9 weeks gestation).^[71] Medical abortions accounted for 32% of first trimester abortions at Planned Parenthood clinics in the United States in 2008.^[72]

Abortion and religion

Abortion is common among religiously identified women. According to the Guttmacher Institute, "[m]ore than 7 in 10 U.S. women obtaining an abortion report a religious affiliation (37% protestant, 28% Catholic and 7% other), and 25% attend religious services at least once a month. The abortion rate for protestant women is 15 per 1,000 women, while Catholic women have a slightly higher rate, 22 per 1,000."^[73]

Abortions and ethnicity

Abortion rates tend to be higher among minority women in the U.S. In 2000-2001 due to lower access to healthcare and contraception. The rates among black and Hispanic women were 49 per 1,000 and 33 per 1,000, respectively, vs. 13 per 1,000 among non-Hispanic white women. Note that this figure includes all women of reproductive age, including women that are not pregnant. In other words, these abortion rates reflect the rate at which U.S. women of reproductive age have an abortion each year.^[74] While White women obtain 60% of all abortions, African American women are three times more likely to have an abortion.^[75]

In 2004, the rates of abortion by ethnicity in the U.S. were 50 abortions per 1,000 black women, 28 abortions per 1,000 Hispanic women, and 11 abortions per 1,000 white women.^[76]

Reasons for abortions

Another study, in 1998, revealed that in 1987-1988 women reported the following as their primary reasons for choosing an abortion:^[77][78] The source of this information, takes findings into account from 27 nations including the United States, and therefore these findings may not be typical for any one nation.

• 25.9% Want to postpone childbearing.
• 21.3% Cannot afford a baby
• 14.1% Has relationship problem or partner does not want pregnancy
• 12.2% Too young; parent(s) or other(s) object to pregnancy
• 10.8% Having a child will disrupt education or job
• 7.9% Want no (more) children
• 3.3% Risk to fetal health
• 2.8% Risk to maternal health
• 2.1% Other

According to a 1987 study that included specific data about late abortions (i.e. abortions "at 16 or more weeks' gestation"),^[79] women reported that various reasons contributed to their having a late abortion:

• 71% Woman did not recognize she was pregnant or misjudged gestation
• 48% Woman found it hard to make arrangements for abortion
• 33% Woman was afraid to tell her partner or parents
• 24% Woman took time to decide to have an abortion
• 8% Woman waited for her relationship to change
• 8% Someone pressured woman not to have abortion
• 6% Something changed after woman became pregnant
• 6% Woman did not know timing is important
• 5% Woman did not know she could get an abortion
• 2% A fetal problem was diagnosed late in pregnancy
• 11% Other.

In 2000, cases of rape or incest accounted for 1% of abortions.^[80]

A 2004 study by the Guttmacher Institute reported that women listed the following amongst their reasons for choosing to have an abortion:^[78]

• 74% Having a baby would dramatically change my life
• 73% Cannot afford a baby now
• 48% Do not want to be a single mother or having relationship problems
• 38% Have completed my childbearing
• 32% Not ready for another child
• 25% Do not want people to know I had sex or got pregnant
• 22% Do not feel mature enough to raise another child
• 14% Husband or partner wants me to have an abortion
• 13% Possible problems affecting the health of the fetus
• 12% Concerns about my health
• 6% Parents want me to have an abortion
• 1% Was a victim of rape
• less than 0.5% Became pregnant as a result of incest

A 2008 National Survey of Family Growth (NSFG) shows that rates of unintended pregnancy are highest among Blacks, Hispanics, and women with lower socio-economic status.^[81]

• 70% of all pregnancies among Black women were unintended
• 57% of all pregnancies among Hispanic women were unintended
• 42% of all pregnancies among White women were unintended

When women have abortions (by gestational age)

According to the Centers for Disease Control, in 2011, most (64.5%) abortions were performed by ≤8 weeks' gestation, and nearly all (91.4%) were performed by ≤13 weeks' gestation. Few abortions (7.3%) were performed between 14–20 weeks' gestation or at ≥21 weeks' gestation (1.4%). From 2002 to 2011, the percentage of all abortions performed at ≤8 weeks' gestation increased 6%. ^[82]

Abortion in the United States by gestational age, 2004. (Data source: Centers for Disease Control and Prevention)

Death

In the US, risk of death (of the mother) by abortion is lower than childbirth for pregnancies terminated at or before 21 weeks' gestation.^[83][84]

Public opinion

Leading up to the 40th anniversary of the Roe v. Wade Supreme Court decision in January 2013, a majority of Americans believed abortion should be legal in all or most cases, according to a poll by NBC News and the Wall Street Journal.^[85] As well, approximately 70% of respondents oppose Roe v. Wade being overturned, which is the highest percentage on this question since 1989.^[85] A poll by the Pew Research Center yielded similar results.^[86] Moreover, 48% of Republicans opposed overturning Roe, compared to 46% who supported overturning it.^[86]

Gallup notes that abortion attitudes are shifting. Gallup declared in May 2010 that more Americans identifying as "pro-life" is "the new normal", while also noting that there had been no increase in opposition to abortion. It suggested that political polarization may have prompted more Republicans to call themselves "pro-life".^[87] The terms "pro-choice" and "pro-life" do not always reflect a political view or fall along a binary; in one Public Religion Research Institute poll, seven in ten Americans described themselves as "pro-choice" while almost two-thirds described themselves as "pro-life". The same poll found that 56% of Americans were in favor of legal access to abortion in all or some cases.^[88]

By gender, age, party, and region

Pew Research Center polling shows little change in views from 2008 to 2012; modest differences based on gender or age.^[89]
(The original article's table also shows by party affiliation, religion, and education level.)

A January 2003 CBS News/New York Times poll examined whether Americans thought abortion should be legal or not, and found variations in opinion which depended upon party affiliation and the region of the country.^[90] The margin of error is +/- 4% for questions answered of the entire sample ("overall" figures) and may be higher for questions asked of subgroups (all other figures).^[90]

By trimester of pregnancy

A CNN/USA Today/Gallup poll in January 2003 asked about the legality of abortion by trimester, using the question, "Do you think abortion should generally be legal or generally illegal during each of the following stages of pregnancy?" ^[91] This same question was also asked by Gallup in March 2000 and July 1996.^[92][93] Polls indicates general support of abortion during the first trimester although support drops dramatically for abortion during the second and third trimester.

By circumstance or reasons

According to Gallup's long-time polling on abortion, the majority of Americans are neither strictly Pro-Life or Pro-Choice; it depends upon circumstances. Gallup polling from 1996 to 2009 consistently reveals that when asked the question, "Do you think abortions should be legal under any circumstances, legal only under certain circumstances, or illegal in all circumstances?", Americans repeatedly answer 'legal only under certain circumstances'. According to the poll, in any given year 48-57% say legal only under certain circumstances (for 2009, 57%), 21-34% say legal under any circumstances (for 2009, 21%), and 13-19% illegal in all circumstances (for 2009, 18%), with 1-7% having no opinion (for 2009, 4%).^[92]

"Do you think abortions should be legal under any circumstances, legal only under certain circumstances, or illegal in all circumstances?"

According to the aforementioned poll,^[92] Americans differ drastically based upon situation of the pregnancy, suggesting they do not support unconditional abortions. Based on two separate polls taken May 19–21, 2003, of 505 and 509 respondents respectively, Americans stated their approval for abortion under these various circumstances:

Another separate trio of polls taken by Gallup in 2003, 2000, and 1996,^[92] revealed public support for abortion as follows for the given criteria:

Gallup furthermore established public support for many issues supported by the Pro-Life community and opposed by the Pro-Choice community:^[92]

An October 2007 CBS News poll explored under what circumstances Americans believe abortion should be allowed, asking the question, "What is your personal feeling about abortion?" The results were as follows:^[91]

Additional polls

Results of Gallup opinion poll in USA since 1975 - legal restriction of abortion^[94]

• A June 2000 Los Angeles Times survey found that, although 57% of polltakers considered abortion to be murder, half of that 57% believed in allowing women access to abortion. The survey also found that, overall, 65% of respondents did not believe abortion should be legal after the first trimester, including 72% of women and 58% of men. Further, the survey found that 85% of Americans polled supported abortion in cases of risk to a woman's physical health, 54% if the woman's mental health was at risk, and 66% if a congenital abnormality was detected in the fetus.^[95]
• A July 2002 Public Agenda poll found that 44% of men and 42% of women thought that "abortion should be generally available to those who want it", 34% of men and 35% of women thought that "abortion should be available, but under stricter than limits it is now", and 21% of men and 22% of women thought that "abortion should not be permitted".^[96]
• A January 2003 ABC News/Washington Post poll also examined attitudes towards abortion by gender. In answer to the question, "On the subject of abortion, do you think abortion should be legal in all cases, legal in most cases, illegal in most cases or illegal in all cases?", 25% of women responded that it should be legal in "all cases", 33% that it should be legal in "most cases", 23% that it should be illegal in "most cases", and 17% that it should be illegal in "all cases". 20% of men thought it should be legal in "all cases", 34% legal in "most cases", 27% illegal in "most cases", and 17% illegal in "all cases".^[96]
• Most Fox News viewers favor both parental notification as well as parental consent, when a minor seeks an abortion. A Fox News poll in 2005 found that 78% of people favor a notification requirement, and 72% favor a consent requirement.^[97]
• An April 2006 Harris poll on Roe v. Wade, asked, "In 1973, the U.S. Supreme Court decided that states' laws which made it illegal for a woman to have an abortion up to three months of pregnancy were unconstitutional, and that the decision on whether a woman should have an abortion up to three months of pregnancy should be left to the woman and her doctor to decide. In general, do you favor or oppose this part of the U.S. Supreme Court decision making abortions up to three months of pregnancy legal?", to which 49% of respondents indicated favor while 47% indicated opposition. The Harris organization has concluded from this poll that "49 percent now support Roe vs. Wade."^[98]
• Two polls were released in May 2007 asking Americans "With respect to the abortion issue, would you consider yourself to be pro-choice or pro-life?" May 4 through 6th, a CNN poll found 45% said pro-choice and 50% said pro-life.^[99] Within the following week, a Gallup poll found 50% responding pro-choice and 44% pro-life.^[100]
• In 2011, a poll conducted by the Public Religion Research Institute found that 43% of respondents identified themselves as both "pro-life" and "pro-choice".^[101]

Partial birth abortion

"Partial-Birth abortion" is a non-medical term for a procedure called intact dilation and extraction used by those who oppose the procedure. A Rasmussen Reports poll four days after the Supreme Court's opinion in Gonzales v. Carhart found that 40% of respondents "knew the ruling allowed states to place some restrictions on specific abortion procedures." Of those who knew of the decision, 56% agreed with the decision and 32% were opposed.^[102] An ABC poll from 2003 found that 62% of respondents thought partial-birth abortion should be illegal; a similar number of respondents wanted an exception "if it would prevent a serious threat to the woman's health." Additional polls from 2003 found between 47–70% in favor of banning this type of abortion and between 25–40% opposed.^[103]

Gallup has repeatedly queried the American public on this issue, as seen on its Abortion page:^[92]

Abortion financing

State Medicaid coverage of medically necessary abortion services.
Navy blue: Medicaid covers medically necessary abortion for low-income women through legislation
Royal blue: Medicaid covers medically necessary abortions for low-income women under court order
Gray: Medicaid denies abortion coverage for low-income women except for cases of rape, incest, or life endangerment.

The abortion debate has also been extended to the question of who pays the medical costs of the procedure, with some states using the mechanism as a way of reducing the number of abortions. The cost of an abortion varies depending on factors such as location, facility, timing, and type of procedure. In 2005, a nonhospital abortion at 10 weeks' gestation ranged from $90 to $1,800 (average: $430), whereas an abortion at 20 weeks' gestation ranged from $350 to $4,520 (average: $1,260). Costs are higher for a medical abortion than a first-trimester surgical abortion.

Medicaid

The Hyde Amendment is a federal legislative provision barring the use of federal Medicaid funds to pay for abortions except for rape and incest.^[104] The provision, in various forms, was in response to Roe v. Wade, and has been routinely attached to annual appropriations bills since 1976, and represented the first major legislative success by the pro-life movement. The law requires that states cover abortions under Medicaid in the event of rape, incest, and life endangerment. Based on the federal law:

• 32 states and DC fund abortions through Medicaid only in the cases of rape, incest, or life endangerment. SD covers abortions only in the cases of life endangerment, which does not comply with federal requirements under the Hyde Amendment. IN, UT and WI have expanded coverage to women whose physical health is jeopardized, and IA, MS, UT and VA also include fetal abnormality cases.
• 17 states (AK, AZ, CA, CT, HI, IL, MD, MA, MN, MT, NJ, NM, NY, OR, VT, WA, WV) use their own funds to cover all or most "medically necessary" abortions sought by low-income women under Medicaid, 13 of which are required by State court orders to do so.^[105]

Private insurance

• 5 states (ID, KY, MO, ND, OK) restrict insurance coverage of abortion services in private plans: OK limits coverage to life endangerment, rape or incest circumstances; and the other four states limit coverage to cases of life endangerment.
• 12 states (CO, IL, KY, MA, MS, NE, ND, OH, PA, RI, SC, VA) restrict abortion coverage in insurance plans for public employees, with CO and KY restricting insurance coverage of abortion under any circumstances.
• U.S. laws also ban federal funding of abortions for federal employees and their dependents, Native Americans covered by the Indian Health Service, military personnel and their dependents, and women with disabilities covered by Medicare.^[106]

Positions of U.S. political parties

Though members of both major political parties come down on either side of the issue, the Republican Party is often seen as being pro-life, since the official party platform opposes abortion and considers unborn children to have an inherent right to life. Republicans for Choice represents the minority of that party. In 2006 pollsters found that 9% of Republicans favor the availability of abortion in most circumstances.^[107] Of Republican National Convention delegates in 2004, 13% believed that abortion should be generally available, and 38% believed that it should not be permitted. The same poll showed that 17% of all Republican voters believed that abortion should be generally available to those who want it, while 38% believed that it should not be permitted.^[108]

The Democratic Party platform considers abortion to be a woman's right. Democrats for Life of America represents the minority of that party. In 2006 pollsters found that 74% of Democrats favor the availability of abortion in most circumstances.^[107] However, a Zogby International poll in 2004 found that 43% of all Democrats believed that abortion "destroys a human life and is manslaughter."^[109] Of Democratic National Convention delegates in 2004, 75% believed that abortion should be generally available, and 2% believed that abortion should not be permitted. The same poll showed that 49% of all Democratic voters believed that abortion should be generally available to those who want it, while 13% believed that it should not be permitted.^[110]

The Green Party of the United States supports abortion as a woman's right.

The Libertarian Party platform (2012) states that "government should be kept out of the matter, leaving the question to each person for their conscientious consideration."^[111] Abortion is a contentious issue among Libertarians, and the Maryland-based organization Libertarians for Life opposes the legality of abortion in most circumstances. See also Libertarian perspectives on abortion.

In the United States the abortion issue has become deeply politicized: in 2002, 84% of state Democratic platforms supported the right to having an abortion while 88% of state Republican platforms opposed it. This divergence also led to Christian Right organizations like Christian Voice, Christian Coalition and Moral Majority having an increasingly strong role in the Republican Party. This opposition has been extended under the Foreign Assistance Act: in 1973 Jesse Helms introduced an amendment banning the use of aid money to promote abortion overseas, and in 1984 the Mexico City Policy prohibited financial support to any overseas organization that performed or promoted abortions. The "Mexico City Policy" was revoked by President Bill Clinton and subsequently reinstated by President George W. Bush. President Barack Obama overruled this policy by Executive Order on January 23, 2009.^[112]

The official platforms of the major political parties in the US are as follows:

Republican Party

• 2012: "We support a human life amendment to the Constitution and endorse legislation to make clear that the Fourteenth Amendment's protections apply to unborn children. We oppose using public revenues to promote or perform abortion or fund organizations which perform or advocate it and will not fund or subsidize health care which includes abortion coverage. We support the appointment of judges who respect traditional family values and the sanctity of innocent human life. We oppose the nonconsensual withholding or withdrawal of care or treatment, including food and water, from people with disabilities, including newborns, as well as the elderly and infirm, just as we oppose active and passive euthanasia and assisted suicide."^[113]
• 2008: "Faithful to the first guarantee of the Declaration of Independence, we assert the inherent dignity and sanctity of all human life and affirm that the unborn child has a fundamental individual right to life which cannot be infringed. We support a human life amendment to the Constitution, and we endorse legislation to make clear that the Fourteenth Amendment's protections apply to unborn children. We oppose using public revenues to promote or perform abortion and will not fund organizations which advocate it. We support the appointment of judges who respect traditional family values and the sanctity and dignity of innocent human life..."^[114]
• 2004: "As a country, we must keep our pledge to the first guarantee of the Declaration of Independence. That is why we say the unborn child has a fundamental individual right to life which cannot be infringed. We support a human life amendment to the Constitution and we endorse legislation to make it clear that the Fourteenth Amendment's protections apply to unborn children. Our purpose is to have legislative and judicial protection of that right against those who perform abortions. We oppose using public revenues for abortion and will not fund organizations which advocate it. We support the appointment of judges who respect traditional family values and the sanctity of innocent human life."^[115]
• 2000: "Ban abortion with Constitutional amendment. We say the unborn child has a fundamental right to life. We support a human life amendment to the Constitution and we endorse legislation that the 14th Amendment's protections apply to unborn children. Our purpose is to have legislative and judicial protection of that right against those who perform abortions. We oppose using public revenues for abortion and will not fund organizations which advocate it. We support the appointment of judges who respect the sanctity of innocent human life." ^[116]
• 2000: "Alternatives like adoption, instead of punitive action. Our goal is to ensure that women with problem pregnancies have the kind of support, material and otherwise, they need for themselves and for their babies, not to be punitive towards those for whose difficult situation we have only compassion. We oppose abortion, but our pro-life agenda does not include punitive action against women who have an abortion. We salute those who provide alternatives to abortion and offer adoption services." ^[116]
• 1996: "The unborn child has a fundamental individual right to life which cannot be infringed. We support a human life amendment to the Constitution and we endorse legislation to make clear that the Fourteenth Amendment's protections apply to unborn children.^[117]

Democratic Party

• 2012: "The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman's right to make decisions regarding her pregnancy, including a safe and legal abortion, regardless of ability to pay. We oppose any and all efforts to weaken or undermine that right. Abortion is an intensely personal decision between a woman, her family, her doctor, and her clergy; there is no place for politicians or government to get in the way."^[118]
• 2008: "The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman's right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right.The Democratic Party also strongly supports access to affordable family planning services and comprehensive age-appropriate sex education which empower people to make informed choices and live healthy lives. We also recognize that such health care and education help reduce the number of unintended pregnancies and thereby also reduce the need for abortions. The Democratic Party also strongly supports a woman's decision to have a child by ensuring access to and availability of programs for pre and post natal health care, parenting skills, income support, and caring adoption programs." ^[119]
• 2004: "Support right to choose even if mother cannot pay. Because we believe in the privacy and equality of women, we stand proudly for a woman's right to choose, consistent with Roe v. Wade, and regardless of her ability to pay. We stand firmly against Republican efforts to undermine that right. At the same time, we strongly support family planning and adoption incentives. Abortion should be safe, legal, and rare."^[120]
• 2000: "Choice is a fundamental, constitutional right. Democrats stand behind the right of every woman to choose. We believe it is a constitutional liberty. This year's Supreme Court ruling show us that eliminating a woman's right to choose is only one justice away. Our goal is to make abortion more rare, not more dangerous. We support contraceptive research, family planning, comprehensive family life education, and policies that support healthy childbearing." ^[121]
• 1996: "Our goal is to make abortion less necessary and more rare, not more difficult and more dangerous. We support contraceptive research, family planning, comprehensive family life education, and policies that support healthy childbearing. For four years in a row, we have increased support for family planning. The abortion rate is dropping. Now we must continue to support efforts to reduce unintended pregnancies, and we call on all Americans to take personal responsibility to meet this important goal."^[122]

Effects of legalization

The risk of death due to legal abortion has fallen considerably since legalization in 1973, due to increased physician skills, improved medical technology, and earlier termination of pregnancy.^[123] From 1940 through 1970, deaths of pregnant women during abortion fell from nearly 1,500 to a little over 100.^[123] According to the Centers for Disease Control, the number of women who died in 1972 from illegal abortion was thirty-nine (39).^[124] In 1960, Dr. Mary Calderone, a former director of Planned Parenthood, said:

The Roe effect is an hypothesis which suggests that since supporters of abortion rights cause the erosion of their own political base by having fewer children, the practice of abortion will eventually lead to the restriction or illegalization of abortion. The legalized abortion and crime effect is another controversial theory that posits legal abortion reduces crime, because unwanted children are more likely to become criminals.

Since Roe v Wade, there have been numerous attempts to reverse the decision. In the 2011 election season, Mississippi placed an amendment on the ballot that redefine how the state viewed abortion. The personhood amendment defined personhood as "every human being from the moment of fertilization, cloning or the functional equivalent thereof". If passed, it would have been illegal to get an abortion in the state.^[126]

On July 11, 2012, a Mississippi federal judge ordered an extension of his temporary order to allow the state's only abortion clinic to stay open. The order will stay in place until U.S. District Judge Daniel Porter Jordan III can review newly drafted rules on how the Mississippi Department of Health will administer a new abortion law. The law in question came into effect on July 1.^[127]

Unintended live birth

Although it is uncommon, women sometimes give birth in spite of an attempted abortion.^{[128][129][130][131][132][133][134]} Reporting of livebirth after attempted abortion may not be consistent from state to state, but 38 were recorded in one study in upstate New York in the two-and-a-half years before Roe v. Wade.^[135] Under the Born-Alive Infants Protection Act of 2002, medical staff must report live birth if they observe any breathing, heartbeat, umbilical cord pulsation, or confirmed voluntary muscle movement, regardless of gestational age.^[136][137] To ensure the success of the abortion procedure, doctors are advised to induce fetal death before abortion procedures after 21 weeks gestation, especially when performing induced labor abortion.^{[138][139][140]}

See also

• Abortion by country
• Abortion and religion
• Catholic Church and abortion in the United States
• Feminism in the United States
• Types of abortion restrictions in the United States
• Reproductive rights
• Anti-abortion violence in the United States
• War on Women

Notable cases

• Becky Bell, an American teenage girl who died as a result of an unsafe abortion in 1988.
• Sherri Finkbine, an actress who had difficulty seeking an abortion for her Thalidomide deformed baby.
• Gerardo Flores, convicted in 2005 on two counts of capital murder for giving his girlfriend, who was carrying twins, an at-home abortion.
• Gerri Santoro, an American woman who died because of an illegal abortion in 1964.

Notes and references

External links

• Full Text of Roe v. Wade Decision
• Interactive maps comparing U.S. abortion restrictions by state
• Number of Abortions - Abortion Counters